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Type I cryoglobulinemia and multiple myeloma presenting with widespread livedo reticularis and skin necrosis
Chao-Chun Yang, Tzu-Kai Lin, Julia Yu-Yun Lee
Dermatol Sinica 23:17-20,2005

Cryoglobulins are reversibly cold-precipitating, circulating immunoglobulins which can lead to clinical symptoms, such as recurrent palpable purpura, polyarthralgia and renal disease. A 65-year-old Taiwanese man presented with widespread, severe livedo reticularis of all four extremities with acrocyanosis, Raynaud’s phenomenon, and eventuated in necrosis of auricular helices, scrotum and fingers after repeated cold exposure. Biopsy of livedo reticularis revealed dermal thrombosis with mixed inflammatory infiltrates in and around vessel walls, and biopsy of a gangrenous lesion showed similar occlusive vasculopathy with ischemic necrosis the skin. Further studies confirmed the presence of type I cryoglobulinemia and the diagnosis of IgG-kappa multiple myeloma. Due to the frequent association with underlying hematological disorders, autoimmune diseases and infections, thorough examination in a patient with cryoglobulinemia should be performed.

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